Increased 24-hour urinary cortisol excretion in patients with post-traumatic stress disorder & patients with major depression, but not in patients with fibromyalgia (FM)

There is now firm evidence that major depression is

accompanied by increased baseline activity of the

hypothalamic-pituitary-adrenal (HPA) axis, as assessed by

means of 24-h urinary cortisol (UC) excretion. Recently, there

were some reports that fibromyalgia and post-traumatic stress

disorder (PTSD), two disorders which show a significant

amplitude of depressive symptoms, are associated with changes

in the baseline activity of the HPA axis, such as low 24-h UC


. The aim of the present study was to examine 24-h UC

excretion in fibromyalgia and PTSD patients compared to normal

controls and patients with major depression. In the three

patient groups, severity of depressive symptoms was measured

by means of the Hamilton Depression Rating Scale (HDRS) score.

Severity of fibromyalgia was measured using a dolorimetrically

obtained myalgic score, and severity of PTSD was assessed by

means of factor analytical scores computed on the items of the

Composite International Diagnostic Interview (CIDI), PTSD

Module. Patients with PTSD and major depression had

significantly higher 24-h UC excretion than normal controls

and fibromyalgia patients. At a threshold value of > or = 240

micrograms/24 h, 80% of PTSD patients and 80% of depressed

patients had increased 24 h UC excretion with a specificity of


There were no significant differences in 24-h UC

excretion either between fibromyalgia patients and normal

controls, or between patients with major depression and PTSD

patients. In the three patient groups, no significant

correlations were found between 24-h UC excretion and the HDRS

score. In fibromyalgia, no significant correlations were found

between 24-h UC excretion and the myalgic score. In PTSD, no

significant correlations were found between 24-h UC excretion

and severity of either depression-avoidance or anxiety-

arousal symptoms. In conclusion, this study found increased

24-h UC excretion in patients with PTSD comparable to that in

patients with major depression, whereas in fibromyalgia no

significant changes in 24- h UC were found.

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